Gut Health for Kids & Teens with Dr. Elisa Song

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Hey everyone. Today I spoke with Dr. Elisa Song. She is a medical doctor who is trained as a holistic pediatrician. She's done training at nyu, Stanford and at UCSF and her skill set ranges from functional medicine to nutrition to homeopathy, herbals, acupuncture and on so a great person to speak with to bring you perspectives on what to do for children, whether it's young children or even teens. We'll talk about both regarding their gut health and how this influences their behavior, their mental health, and how as parents and healthcare providers we should be addressing conversations, especially with kids, about their health, about their diet, so as to not push them into a situation wherein they're really resisting change. And we can find that optimal balance of offering kids and children solutions without making them feel resistant to improving their health, changing their diets, what have you. There were a couple points on probiotics with which I didn't agree with Elisa's perspective, which is totally fine and what I elected to do here, and I'd be curious to get your perspective on this, was rather than going sort of back and forth comparing our rationales, I wanted to let her make that point and I'll edit in afterwards my perspective on mainly probiotics for dysbiosis in children so that we could preserve our time together. To really harvest from her mind as many of the pearls she has as someone practicing pediatrics working with kids. But if you'd think it better for me to kind of get into back and forth on comparing rationales on finer points regarding probiotics or whatever it may be, let me know in the comments or let me know on social media and I'll sort of change the way I handle this going forward. But again, my perspective is when there's a point within my area of domain expertise and I don't agree with a guest, I'd rather let them make their point and move on to harvesting as much of their expertise as we can and not sort of make it this this Sort of back and forth on a given point. But any case, let me know what you think, what you prefer experimenting with this newer format, zooming way out. Really appreciate her perspective. I think she has a ton to offer for children. And if you have or will be having a child and you're trying to optim their gut health, their brain health, meaning their mood, also their sleep, how to handle these conversations, like I alluded to a moment ago regarding improving their diet without putting the kid in a position where he's really or she's really going to dig their heels in, then I think this conversation will be chock full of resources for you. Okay. And with that we will go to the conversation with Dr. Alisa Song.

Hi everyone. Today I'm here with Dr. Elisa Song and we are going to be talking about pediatric gut health, pediatric health in general, teen gut health and sort of the gut brain connection and just picking your brain as much as we can for whatever pearls you have to share. So excited to have you here and have this conversation.

Thank you so much. I'm really, really honored to be here with you today.

Yeah. You know, this is a topic that I think is crucially important because as I discussed way back in Healthy Good Healthy youy, the microbiota in the gut and the immune system form in tandem in the first few years of life, as I of course know, you know, but just for our audience. And that can set partially the tone of gut health and immune system function for one's entire life. Now as an adult, there's a whole bunch of things we can do to improve one's gut health, one's immune system status. So it's not, you know, a fate that's written in, in stone. But if we can be intelligent, let's say a child is having lots of regurgitation and you know, there we have this fork in the road. Do we suppress with PPIs or do we try to fix the problem? And if we fix the problem, we might be actually fixing a few other things that lead to better immune, metabolic, neurological function then and throughout the course of their development. Which is why I think it's so crucial to intervene here appropriately.

Yeah, I mean it's so important. The, the developing immune system really mirrors the developing gut microbiome. And, and as you know, I mean the microbiome and many of your listeners know, I mean at least 70%, 80% of our immune system resides in our gut. So our gut microbiome in an infant when they're out from the womb and you know, have this Quote, sterile, which gut that comes out and is impacted by how they're born, you know, how they're fed, their exposures to other family members and pets. So the shaping of their microbiome then informs how their immune system approaches infections, toxins, you know, foods. And so, you know, we know there's one study, this is back now in 2016, a really large military study, almost 800,000 children. And they looked at these kids records and identified kids who had received antibiotics or as you mentioned, reflux medicines, antacid medications in the first six months of life. And what they found, that in those children there was an increased risk of virtually every single allergic disease, including eczema. One in five kids now has eczema, asthma. At least one in ten kids has asthma. You know, allergies, anaphylactic food allergies are becoming increasingly common. And then we have to remember also the gut brain connection, because what's fascinating to me is, you know, we think we are our brain, right? Our brain dictates who we are. But what they found in infants is that the composition, the diversity and the composition of, of their gut microbiota can actually inform their IQ and their temperament. And so, you know, we see this explosion of the gut microbiome in infants in the first zero to maybe three years of life. Ish. And so, and the, the development of, of the brain synapses, it's like this rose bush going crazy, right? All of these synaptic brain connections are exploding in those same few months of life. And it's actually probably more the gut microbiome leading that charge in their brain and determining, you know, which synapses are really going to stay or develop. That same explosion and change in the gut microbiome that mirrors brain synaptic formation occurs during your teenage years. It's fascinating. So we have these golden opportunities to really impact, support, nurture, nourish a child's gut microbiome, which then will have tons of downstream effects on their immune system, on their brain, on their hormones, I mean, pretty much every single system. So one study that I saw that was a little bit, you know, I don't want to say frightening, it's just we need to be aware of this. But another study looked at children who received antibiotics when they were younger and found that if they received antibiotics as infants or toddlers, there was an increased risk of almost every mental health disease in older kids and teenagers. And so it starts when they're young, right, that disruption to the gut microbiome. And so, and the more the Rounds of antibiotics, the more that the risk, the higher the risk of mental health disease when they were older children. And we know we're in a state of mental health emergency for our kids.

Yeah, I mean, incredibly well said. And I love the fact that you weave studies into this. I think our audience will appreciate that. It's one of the things that we try to do wherein we have this framework, this sort of ancestral health framework, and we want to look to research to know when that framework is correct, when maybe we want to modify or think a little bit differently or just otherwise really inform us in terms of what we're learning with more contemporary research and how that may influence thinking about mental health. Antibiotics. And as you're describing the scenario of mental health, whether it be in infants or children, I always picture a parent somewhere in public with a kid who is just kind of going crazy. And one of the first things I think is, you know, what's going on with a child's diet, with their gut health. And I also juxtapose that with what I'm sure many of the people listening to or watching this have experienced. When my gut health is off, I feel it with my mood, with my energy, as something I myself have experienced. So the same thing applies to children. And what's also, I think, unfortunate is it's. There's so much less in terms of conversations and tools for parents to bring to their kids when they're having these problems. I think that's starting to improve. Right. And likely the cohort of people that get the interventions first are the adults, because they're the ones who can sort of, you know, piece together, well, when my bloating is worse, I'm more depressed. And I tried an antidepressant, didn't like how I felt. So now I'm going to go on the Internet and do some research. And so because there's more demand there, you see more popping up in terms of therapeutic offerings. But now there's hopefully a spillover to kids. And one of the areas where I think the conversation has been fairly robust is regarding antibiotics. And I think I'm familiar with the study that you mentioned, and there's been a couple others that have stratified toward antibiotics the first two months of life, the first maybe four months, six months. And thankfully, they do find the later that they're administered the antibiotics, the less deleterious. So one of the recommendations I've given is put off antibiotics as long as you can. However, that also begs the question, well, what is the person dealing with Right. Because not every instance for antibiotic is the same. And that's where I'd be curious, is kind of a broad brush to paint with. But are there certain times and places, conditions where you think, okay, right now the risk reward favors use of an antibiotic. And in these other cases, you'd really be better off doing probiotics or dietary changes or whatever before going to an antibiotic.

Yeah, well, I mean, the challenging part is we can see that disruption to the gut microbiome in infancy has a more profound impact on future health, brain immune health for your child. Now, the problem there is in infancy, if your child has an infection, a bacterial infection, it's probably even more important to get the antibiotic right. And so, you know, we're kind of in this catch 22 now, you know, children, and you know, for children under a month of age, and certainly a month of age, but even three months of age, if they have a fever, there are guidelines on how to work up that fever in that child because their immune system is still very young and vulnerable. So they more like they are more easily tip over into very serious bacterial infections. So often those cases, they'll have a quote rule out where they'll do the blood cultures and they'll do the urine cultures and maybe even spinal fluid. And while they're waiting for those results, because those infants might get sick very quickly, babies are sometimes admitted to the hospital, given antibiotics to observe while waiting for negative results. Now that, you know, so there's that scenario. But more often than not, there's a lot of wiggle room here, right? And you know, one study found that, you know, up to 70% of all two year olds has received at least one round of antibiotics. I mean, that's a lot, a lot of kids, right? And other studies have shown that at least for older kids, something like three quarters of those prescriptions are inappropriately prescribed either for viral infections. That's the most common, Right. Your kid has a sniffle, a cold, a cough, or whatever it is you.

Get sort of preactively in case there's.

A secondary bacterial either, either. And some parents actually demand that without recognizing some of the studies on why we don't want to do that. Right. But then there's also, you know, ear infections. Earaches are the number one visit to pediatrician's office. And we know that, you know, some ear infections are viral, some infections are bacterial. Even the ear infections that are bacterial, the vast majority will resolve on their own even without antibiotics. And so, you know, this is where knowing that and also I'm going to also recommend to parents if you want to take that wait and see approach, there's a couple of things. I mean, you want to get some more sort of integrative pediatric tools under your belt. I mean, look at the studies. There are some, you know, garlic ear drops that can be really, really beneficial in fighting bacteria and viruses in the ear infections. I use homeopathy in my practice. I use essential oils and acupressure points. So all of those can help your child feel better, faster, recover faster, and help you avoid the use of unnecessary antibiotics. And, and honestly, the thing that if you're, you know, in urgent care, your pediatrician has looked in your child's ear, listened to their lungs, I mean, you want to ask the questions and you know, not in an adversarial way, but just really in a, in a, in a curious way. And also as your, as your child's advocate. Right, yeah. Hey doc, is this antibiotic really necessary? Did you know there was a study that found that doctors who thought that that patient wanted an antibiotic prescription were much more likely to prescribe an antibiotic even if they thought it wouldn't help, that it was viral. So just by asking the question, don't be afraid to ask, right? Ask the question, it lets that doc know. I'm not the parent who just wants a prescription for everything. I want to be thoughtful about this. Is it really necessary? What are my options? What if I don't give the antibiotic? Right.

And I think, I think that's brilliant. And it's one of the things I advise people in our consulting practice just to ask a follow up question, just like you said, in a non adversarial way, because, you know, you don't want to be a jerk. Or they say the world is a mirror. So if you're a jerk, people are going to be jerks back to you. If you're kind and inquisitive and objective, you tend to get that back. But the other thing is just asking something about probability, right? Because what I think parents tend to do, or anyone who's in sort of a fearful situation is they look at an answer as being binary. They need it or they don't. And so if you ask a question framed in a binary yes or no, you kind of force the doctor, unless they're really thinking about it, to give you a yes or no, but not disclose. Well, my yes is based upon a 30% need, I think, and a 70% unnecessary nature of the antibiotic. And so sometimes just Asking, well, you know, what would your probability assessment here be? How likely is it that they need it? Or you know, might we be able to check back in in a few days or a week just so you can make a decision based upon a quantification of risk.

Yeah, I love that. So important. And I think, you know, a lot of, well, you know, as, as I see parents now, as I'm getting older, parents are getting younger and I think that, you know, more, more parents are now in the mindset that yes, they can ask questions and be a team with their doctor, not be, you know, the, the, the patient that has to follow all the doctor's instructions. And, and you know, really I learned so much from my patients. And so the other thing too is if the doctor really thoughtfully answers your questions and says, you know what, in this situation, I really do think the antibiotics are necessary, which I have said that patients. Right. I mean, there is a time and a place for, I'm not going to say everything, but for just about everything. And you know, if they do say the antibiotics are necessary, I mean, the first thing is if you're starting the antibiotics, just finish the course. Because we have too many problems now with antibiotic resistance due to the over prescription of antibiotics, but also kind of inappropriate use of antibiotics. So that is really and truly, I mean, by 2025, some of the reports I've seen, they predict that antibiotic resistance is going to be one of the leading caus of death worldwide. I mean, this is very serious, that we have really good antibiotic stewardship. But let's say the antibiotic is necessary. I mean, then, then the follow up question, as you said, would be, okay, so then how do I support my child's gut microbiome to recover after that? Right. And they may not have an answer for you, but they might. And then, but that at least, you know, lets them know that, that you are, you know, not taking this antibiotic lightly, that you understand that this, that there are some, you know, adverse unintended consequences that you'd like to mitigate.

Sure. And this is why I've become a pretty big proponent of probiotics, especially since we've been doing a podcast monthly updating on the latest research. Right. We have a small team that Fairly obsessively monitors PubMed save search. So anytime something's published, a clinical trial on probiotics, we sort of collate that data and we report to our audience on a monthly basis. And over the past few years it's been quite interesting to see that urtis upper respiratory tract infection incidence or duration can be prevented with probiotics. Gastrointestinal infections of different sorts. Even one study finding improvements in jaundice, which kind of makes sense given the liver gut connection, when probiotics were used either as a monotherapy or in conjunction with an antibiotic. And of course they have an ability to help with preventing secondary imbalances in the wake of an antibiotic. So I've become a pretty big proponent, amongst other things, of probiotics. What's your perspective there? What are you, what are you recommending? Are you seeing certain cohorts when you, you don't advise on a probiotic?

I mean, that's a great question. So I would say, you know, I've been moving more towards really recommending probiotics, you know, more I guess an as needed basis. I mean, really looking at what are we trying to accomplish with these probiotics and gut restoration. You know, post antibiotics is one time where absolutely, you know, there's that one study that, that looked at no intervention probiotics and fecal transplant and found that the gut microbiome restored back to the pre antibiotic state faster with no intervention and with a fecal transplant.

Okay. The first bit of context I wanted to add was on this point. We've discussed at Nauseum this Israeli study, one small study, really at odds with the majority of studies asking the question, what happens when probiotics and antibiotics are given together. So thankfully we have a 2022 systematic review from the Journal of Medical microbiology. It summarized seven randomized control trials of 285 subjects. What they found was that when probiotics were combined with antibiotics, there was a preservation of the microbiota, reductions in diarrhea and other gastrointestinal symptoms, and if people were being treated for H. Pylori, an improvement in the eradication rate of that bacteria. So when looking at the total body of evidence, the one Israeli study, small, about 20 people compared to a systematic review of seven trials in 285 people showing us that you should be using probiotics with antibiotics for all of these reasons. So just wanted to make sure to include the greater context here so that you can make the most informed decision possible.

Small study, right, because then, you know, a lot of people said, well, are probiotics not necessary then after antibiotics, it was a really small study and that, and I looked that probiotic supplements did not contain any prebiotics. It did not have any foundations for those probiotics to really stick because a lot of people Think you throw probiotics into your gut and all of a sudden, I mean, it's like a tomato plant. You wouldn't just throw it into the dirt, walk away with the dirt, you know, dry and clay like and no sun and no water and expect to have a beautiful tomato plant grow. And so we really need those foundations. And most of the studies do show that probiotics alongside antibiotics, you start during the course of the antibiotics and you continue might take a month or two for gut restoration to occur.

Right.

That, that, that's actually the most beneficial. So then we get to, well, what about for kids specifically? And when you look at the, you know, scour through PubMed, I mean this is not just with probiotic and gut health data. This is just kid research in general is, you know, vastly underfunded compared to adult research. So, you know, it's, it's really a shame because it's in the pediatric group where no, they're not, you know, they don't necessarily have all of the chronic diseases that adults have, but they're catching up, you know, pretty quickly. Right. And that's where we can, you know, really do some good prevention. But there, there is.

You know, significantly less clinical research in children on, you know, the, on probiotic supplementation. Now there are some strains that are really, you know, well studied like Lactobacillus rhamnosis gg, that's the most studied probiotic in children, infants and children. But it has to be strain specific. Right. So the Lactobacillus rimnosis, the substrain gg, there's one Lactobacillus ruderi, it's. Oh my gosh, I can't remember the dsm. Let me look and see. I wrote this down because I want to give it DSM17938. Now that is found in a probiotic called Biogaia and that has found to significantly reduce colic fussiness in infants. Now there's another Lactobacillus rooter eye strain that if you were to use that and think, oh, this is the one that I should use for my baby, it's actually for vaginal health. And so, you know, you want it, which would be great for mom, right? But it's not necessarily going to be benefit the kids. Now.

Some of this, as you mentioned, what I recommend over the wintertime there is a probiotic that has immune supporting strains. So there are a couple of strains that have been found in children in the research to significantly reduce the numbers of fevers, antibiotic prescriptions, upper respiratory Tract infections if taken through the winter. So that's where I think, you know, I think probiotics, we are very beneficial, but we really want to be mindful. Let's see, you know, what are the strains we're using? Is there clinical research? Can we extrapolate from adult research to children if there's not pediatric research? Because unfortunately, that's where we are at the moment right now is really extrapolating from adult data, but hopefully we'll get there.

Okay, this was the second point I wanted to add some context to. There are certainly some studies and some researchers claiming that the strain specificity matters. But hopefully, as you are used to, we look at the majority of the data, we look at all the data that we can really and look for what the trend is. And in this case, I'm not convinced that we need strain specificity. This comes from a 2023 review paper from the Journal of Pediatric Gastroenterology and nutrition. They summarized 23 randomized control trials looking at eczema, antibiotic associated diarrhea, acute diarrhea, necrotizing enterocolitis and respiratory tract infections. And what they concluded is very telling. Based on indirect comparisons. This rapid review demonstrates insufficient clinical evidence to support or refute the claim that probiotic effects in children are strain specific. So how I interpret that is there's insufficient evidence to prove that you need a specific strain. Now, there's also insufficient evidence to disprove that. But in the presence of insufficient evidence, it makes the most sense, at least to me, to use the easiest method of application, meaning we can use a generalized protocol and not need to jump through the hoops necessary to use highly specific strains for a given condition. And similar to this, the other claim that we need specific probiotics for specific conditions. So there's kind of two claims. You need a specific strain and you need a specific probiotic. You know, again, I'm not convinced of this. There are a number of trials. A meta analysis looking at colic and regurgitation, summarizing 26 randomized control trials wherein the type of probiotics varied from study to study to study, but they still found benefit. A different meta analysis of 29 randomized control trials, again finding benefit for functional abdominal pain in kids with a variance across studies of the formula used. And Then finally, a 2023 network meta analysis of 163 studies with different formulas being used across the studies, finding that probiotics combined with antibiotics improved the clearance of H. Pylori. So when looking at all these data in total and Just the very simple trend that we're seeing, success with probiotics via different strains and via different formulas for all sorts of different conditions. It makes it really difficult for me to say you have to go through the arduous process of pairing a specific formula with your child's specific symptoms, especially when understanding that the probiotics aren't functioning like drugs. They're helping to heal the gut. And as an offshoot of that, we may see better colic, improved regurgitation, less abdominal pain. And then if your kid does need a antibiotic, a reduction of side effects, and also a preservation of the gut microbiota.

I think that, you know, in addition to probiotics, prebiotics are really, really important. Now there's a kind of a newer kid on the block. It's a, it's a human milk oligosaccharide, so it's, it's the most common. So human milk oligosaccharides are basically prebiotics in breast milk that can nurture and nourish a healthy gut microbiome. You know, the, the positive, the healthy species that support butyrate production, Bifidobacter, in the infant's gut and also actually move out some of the unwanted bacteria in your child's gut. Now, 2 FL or 2 fucosal lactose is the most predominant HMO in human breast milk. And now we have that, we have that ability to not take it from breast milk, but synthesize it, you know, make a 2fl analog. And some infant formulas are putting 2fl into their products. There are freestanding 2fl prebiotic supplements that, you know, really help to, you know, recolonize and repopulate the gut, not just in infants, but there are even some adult studies because butyrate, butyrate is one of the short chain fatty acids that probably is. I mean, it may be the most important reason why probiotics give us such health benefits. It's one of the postbiotic short chain fatty acids for your listeners. Right. And butyrate may be one of the kind of master modulators of our health. And so, you know, 2 FL will promote colonization of organisms that produce butyrate. So, I mean, lots of great stuff. So I think probiotic and the prebiotic are really important.

Yeah, you know, I, I really, actually, I'm excited to watch the body of literature on the human derived lactose prebiotics for kids, because that makes a lot of sense to me, given we're trying to replicate what's occurring in the breast milk. Yeah. So that I'm, I'm excited about that and I think we can make the best case for prebiotics for kids adults. I think the data are a bit more mixed. A recent meta analysis found looking in a model of ibs, no benefit on IBS symptoms with the use of prebiotics and the information. The data on prebiotics is also interesting. It's been evolving and my position has changed most. Namely when this 2020 meta analysis in adults was published looking at three studies and assessing, attempting to assess the effect of prebiotics for adults with IBS and they concluded there was no significant effect of prebiotics on IBS symptoms. That really swayed me. Now I want to pivot over to what does the data say in children? A 2012 systematic review looked at 12 studies and they found some benefit. Prebiotics increased stool frequency but had no impact on consistency of the stool or the incidence of colic, spitting up, regurgitation, crying, restlessness or vomiting.

So continuing, there was no impact on prebiotics on the volume of formula tolerated infections and gastrointestinal microflora. So maybe a small amount of benefit. A 20 or a 2009 rather meta analysis found something similar that probiotics did have an impact on stool frequency and maybe some impact on diarrhea and irritability, but the trend in children seems to be of minimal benefit. Now, all that being said, I agree with Dr. Elisa's comments that the.

Lactose prebiotics for kids is probably a good idea because we want to replicate what is occurring in breast milk. Yes. You know, is it highly effective? I'm not sure. These data don't convince me that there's going to be a big effect. But I still think given the fact that prebiotics don't seem to cause any negative side effects and and again, they're replicating breast milk, it's probably a good idea to use these prebiotics that is in kiddos. But maybe put that aside because the one thing I do want to get your perspective on is the other end of the spectrum with kids and prebiotics, which is low fodmap. Low fodmap, there's some trials finding improvement when the mother's breastfeeding and the child's colicky. If the mother goes low fodmap, there's an improvement in regurgitation, colic fussiness. Is this something that you're advising people on? Are you getting any signal from that intervention?

If so, you mean to put the moms on a low fodmap Diet?

Yeah, the mother on a low fodmap diet.

You know, and there are other studies, like older studies looking at elimination of the common allergens in mom's diet, you know, cow's milk. I would say if your baby's fussy, the first thing I would do is just get rid of cow's milk. I mean, that's, you know, and just see how that is. Because I've had babies where even a drop of creamer in your coffee and babies are really fussy and you get rid of that and all of a sudden, because casein is such an inflammatory protein now. And so, I mean, that's, that would just be the first thing. And, you know, if you're a cheese lover or an ice cream lover, you know, it's, it's for a short time. It's not like your baby will never be able to tolerate that, but you want to give. Your baby's got a little break. You know, when we think about leaky gut, you know, it's, it's kind of a, a funny thing to say that infants have leaky guts, but because they naturally are born with increased intestinal permeability. So is it le or is that just developmentally appropriate? Right. So it's not pathologic for infants to have a, quote, leaky gut. This is how they're. I mean, their gut is immature. But when we have these, you know, larger inflammatory proteins, especially casein, you know, that are entering into your, into your baby's gut, it can really have an impact on, I mean, the gut microbial composition, but also inflammatory markers. Because fussy, colicky babies have been found to have higher levels of fecal calprotectin than non fussy babies. Right. So there's some inflammation. There's clearly a gut component. A lot of parents will say when their babies are cocky, it looks like it's in their gut. They're crunch, they're scrunched over, they're arching their back, they're screaming if they pass gas or if they, you know, can, can poop.

Kind of like an adult, right? Like, oh, I don't feel good, I'm.

Moody, tummies are bloated. And so, you know, I think yes, you know, you can trying a low fodmap site or, you know, trying the dairy elimination first. But also some of the other culprits, more common culprits that I see are citrus, soy, I mean, gluten, sometimes nuts. I mean, it's a, it's a common ones. Yeah, but when you have A nursing mom who has a really fussy baby. The first I look at a couple of things. Nobody sleeps well when you have an infant, right? But. But some, some moms have, you know, lower stress, resilience, less support, maybe. I remember, I mean, even as a pediatrician, when my, my first child, my daughter, was born, I just. I mean, I could feel myself in this fight or flight mode all the time because I wasn't sleeping, and I felt like I couldn't sleep because I had to do X, Y and Z and take care of the baby. Right. And so if you have a fussy baby and you are just, you know, chock full of epinephrine and cortisol, guess what's going to go through the breast milk? Right? And so we really want to nurture mama. So that's first thing, you know, what can you give up? What can you as a mom just say, look, okay, those dishes can wait, or better yet, someone else do the dishes? Right. And then, you know, the other thing, too is when, when babies have, you know, fussiness and a lot of those, those antigenic and inflammatory proteins are getting through mom's breast milk, then also thinking, well, what is mom's gut like? You know, does she have a leaky gut that is allowing her to absorb these inflammatory proteins that then are going through to the baby's breast milk? So really supporting the mom's gut, too, is going to be really important. And, you know, with. With moms, I just always am because I've had some moms where the diet has become so restricted that they're not getting the nourishment they need. And the fascinating thing about breast milk, from an evolutionary standpoint, most components of breast milk don't change that much, even when moms are malnourished. Because we evolutionarily, we were prioritize it. Yeah. I mean, we prioritize feeding this baby. Right. And so the moms are going to lose out. I mean, they're going to get more and more malnourished and harder to really recover from anything they need to. So just making sure that you really work with the mom, have her work with a nutritionist if needed, focusing on all the things that, that she can eat, you know, even coming up with meal plans or, you know, really supporting the mom to feel like moving away from, I can't eat anything to, wow, look at all of the amazing nourishing foods that I can eat that are also nourishing my baby.

Love it. Yeah. And this is something I'm really looking forward to. Expanding on in a moment, which is mindset around diet for both kid and adult. Yeah, but let me pin that just for one minute because I. Before we sort of. I think that's going to take us into sort of teen conversations also won't be a good segue into that topic. But what about formulas? You know, this is something my sister recently had a child and she got hit with so many different options for formulas. And it looked like there may have been cleaner ones in Europe, which I believe you had said, where we initially met in a conference where we were both on like a Q and A panel. And that got me thinking, hmm, you know, this would be a good question to pose. What are the best formulas and what should people be looking for in a formula?

Yeah. So, I mean, it might almost be easier to start with what should you not have in a formula?

And there are, there are more. I mean, with the infant formula shortage that, you know, was occurred during the pandemic, I mean, there, there are newer formula companies that have come on the market that I haven't looked too much at, but there's one, I think it's called Bobby, you know, formula. I think it's called that, that I've been told by some of my other fellow practitioners is, is a good one. Now, in terms of what to look for in general, the European formulas, like Hip Holly Luca, they're. They're cleaner. They're not allowed to have, you know, some of the different emulsifiers and chemicals that are allowed in. In our infant formula. The FDA actually allows, in our infant formula, they can use, you know, cleaner nutrients. You know, the other thing that a lot of people don't realize is that in order to be called an infant formula, the FDA has certain requirements for minimum nutrients that must be in a formula, but they have to also be these precise nutrients. So, for instance, you know, the FDA requires infant formula to have folic acid. Now, if you have a methylation concern, or your kids do, or you presume your kids may, you know, because of family history. Well, if a infant formula manufacturer wants to. You use folate in their formula, then they can't call it a. An infant formula anymore. So that's where some of the toddler formulas, they actually look very similar to infant formulas. If you look at the nutrition panel and see the ingredients, except they may have methylfolate or methylcobalamin. Right.

And then the final point on methylation, I just wanted to add this as an aside. You know, if you'd asked me this maybe five years ago, I would have had a more open minded perspective. But as we've been watching the data, it's important to share a 2016 review paper concluding that there's no evidence that the MTHFR polymorphism has a clinically relevant effect on the folate pathway. A 2019 review found only a 1%. 1% variability in homocysteine levels determined by having the MTHFR polymorphism. And to quote the likelihood of any given genotype resulting in a meaningful difference in phenotype is relatively small, meaning the genes don't really affect your phenotypic expression. And what I found to be very interesting here, this is an adult, but I think it helps with the point. A 2017 randomized control trial in 20,000 adults who were given folic acid who had either hetero or homozygous SNPs in MTHFR, they found a reduction in stroke risk by 15 to 30%. Again giving folic acid, not folate. Folic acid to those with mthfr. So how I interpret these data, you don't need to worry about giving your kid folic acid or need to give them folate instead of folic acid if you yourself have the polymorphism. As we're learning with so many of the gene polymorphisms, the effect size, the magnitude of the effect is so small so as to be insignificant. One theory that was well intentioned and interesting, but even some of the thought leaders in the space, like Ben lynch had been on the podcast and reflected back on how misleading some of the early conclusions were. Probably as per the usual, well intentioned. But as further data has been published, what was interesting we're now discovering was really clinically insignificant. So just the final point there I.

Wanted to add, so that is something to know too, that it may be that looking at a toddler formula like Serenity's A2 formula, I think is a very good one. Now, one thing we don't want in a formula is a sweetener that's not lactose. Now, lactose is the primary fuel for infants and it's a primary carbohydrate found in breast milk. And a lot of people think if my baby's fussy they must be lactose intolerant.

But evolution is so prevalent with, with what we advise adults to avoid.

Exactly.

So yeah, I think it's, it's really important to tie that in. It's such a prominent prebiotic and, and carbohydrate in the breast milk, so we shouldn't be avoiding it.

Yeah, yeah, yeah. So you really want, you don't want corn solids. I mean, you want lactose in there. You want to choose organic. If you can, you know, glyphosate, as, as I'm sure your listeners know, as an herbicide. It was actually initially patented as an antimicrobial. So it will, will, you know, preferentially actually kill the beneficial bacteria and allow the growth of abnormal bacteria like clostridia in your gut. So choosing organic, I would choose powder over the liquid ready to feed the liquid infant formulas. The liquid ones tend to have emulsifiers. Now, emulsifiers are FDA approved food additives that keep food together. You'll find emulsifiers, mono and diglycerides are one that you might see in the ready to feed infant formulas and the use of emulsifiers. I mean, you're gonna look, look when you, the next time you buy ice cream. If you guys are ice cream eaters, just look. I challenged my kids, they wanted ice cream. I said, well, let's look for one that doesn't have these mono and diglycerides in it. And so, you know, it was hard to find one in, in our local grocery store that didn't have those. And why is that important? Because mono diglycerides and emulsifiers can directly trigger leaky gut and, and so aggravate your child's leaky gut.

And, and just as a quick aside on this elisa, there's decently clear data in adults correlating increased emulsification in food products with more inflammatory bowel disease to some extent, I believe, with ibs. So, you know, we have the outcome data too, because one of the things we try to discuss in this podcast is some of these food components look sort of scary, but don't correlate with bad outcomes in humans, and then some do. And, and so we, we try to just report on when do we have a good correlation to an UN mechanism with poor health and with emulsifying agents. There certainly is that data.

Yeah, I love that. And, and I point to, you know, there, it might be the similar paper that, that we're referring to, but there was one study, it was, it was more of a correlation study, but they looked at countries and different countries and you know, the rapid rise of emulsifier use in these countries mirrored the rapid rise in autoimmunity in adult populations. But, you know, if that's happening to the adult gut, I mean, your, your child's gut is more vulnerable to hits than the adult gut.

Sure.

So that is, want to, we want to keep in mind, I mean, it's the same thing.

I never thought of the liquid. No, that, that's, you know, because I actually recommended my sister one that was liquid because it had other, I think health merits to it. But yeah, the emulsifying agents, yeah for some people they're definitely a trigger. So that's great to know.

And you just have to look at the labels because not all of them are going to have that, but they, but they may. And so that's one thing. The other thing too, if your baby is really, really fussy and you're, you're really suspicious that you know dairy so casein, you know, is a, is a problem. There are some, I mean it's Gerber, Gerber Soothe, I think it's called Gerber Soothe anyhow has a whey based formula that seems to be better tolerated for those babies who have, you know, casein problems. More and more formulas because they are really trying to look at breast milk science and mimic the benefits of breast milk. They're putting in that H. The HMOs, the two FL I mentioned, there's one called LNNT and so those also would be great to have in them. So but if you need go on a dairy free formula, you know, is, is soy better? I mean that has its issues too. There are some women who may have access to local breast milk banks to just if you're, if you're nursing and you just need to top off your supply, it may be, you know that you can find a breast milk but unfortunately banked breast milk, human breast milk, it's quite expensive and it's not going to be an option for exclusive feeding. Yeah. For, for most. And the other issue there is while it may have some of the beneficial HMOs in there and even probiotics in breast milk, you don't know what diet that mom had, you know, when, when they were donating milk. And so you know, if your baby is, is you know, sensitive to, to casein to dairy and you know this mom just ate a ton of dairy, it just might not work for your child. And so when I really want to assess does this child have a lot of food, food allergies, food intolerances, this infant, then I, then it really is moving to a hypoallergenic or an elemental formula like Neocate, which I mean they don't taste very good and not organic. But you know, even for a brief trial just to see is, is this part of the picture and then you know you can supplement with extra, extra 2fl for your baby. I think that there's no problem with that. I think that would be very beneficial.

And I'm assuming I haven't looked too deeply into this, but the main difference between adult Elemental and child Elemental is just the nutrients that accompany. Otherwise they're, they're pretty much the same in terms of pre digested protein, carbohydrate, fat. Is that the main difference? Just whatever. Multi, Multivitamin Mineral is a company.

That's such a great question because I don't do an elemental diet, you know, on my, on my older kids, I mean some teens actually. That's not true. I've had some teens and, and kids with, you know, Crohn's disease and you know, IBD that I've, that I've had on elemental diets. But I've never thought about, you know, how does that relate to, you know, elemental Neocate formula? It's.

I'm.

Yeah, I'm going to guess it's very similar for sure.

Okay. Yeah, that might, I think we'll do a follow up query on that because we make our own elemental diets for adults and you know, if you, if you can change the palatability, which you know, can be done with just some meetings and back and forth with a team of food scientists, you can come away with elemental diets that actually taste pretty darn good.

Yeah.

And, and so for adults it's been hugely helpful. And the, the data on inflamma bowel disease, especially Crohn's for kids, I mean we've discussed in the podcast in the past simply supplementing half of a child's calories per day with an elemental for two years. There was less disease activity and better growth outcomes, which is pretty remarkable to see.

Yeah.

But to your point, boy, if we're talking about Vivinex plus the adult formula, I've shared this before, but it literally tastes like you licked a postage stamp. Oh yeah, nasty. So we need the second generation which are much more palatable. But you know, to be like, we'll do some research on the nutrient profile. That's going to be a fun question.

I mean to. There are some. So some families will, you know, this is more. If there is maybe a breast milk supply issue or just inability to breastfeed for whatever reason. I've had some families successfully make homemade formulas. You know, there's a, there are some recipes online. I mean, really quick there.

I wanted to ask you about the Weston A. Price because that's one that my brother had used successfully. I really liked how whole food Based. That was. Is that one that you know of, you recommend?

Yeah. So that's, you know, and that, that one I've had. The Weston A. Price formula uses raw milk and, and really, you know, make sure that all the nutrients are in. I think it can be a good choice. It's just, you just need to make sure that, that you are making it appropriately, storing it appropriately. I mean all, all, all the things. Right. Just making sure that, that it's safe for your child. And this is where the mindset piece comes in. Right. Because it can seem really onerous to some parents to just have to make these batches and batches of milk. But you know, if, if that's your sole baby's sole nutrient source, I mean.

It may be what a good investment.

Yeah. So.

Hey there. This is Erin ryan from the Dr. Ruscio team answering a few of the top questions about our elemental healing. What if I have a whey or milk protein allergy? Well, you can order our whey free version of our elemental heel. I actually have those allergies as well and I do great with the whey free formula.

I have histamine intolerance. Which formula is best? Dr. Ruscio recommends either the low carb vanilla or the whey free peach flavors. Is the whey protein grass fed? Yes, it is. Can I add MCT powder or oil to add calories? So Dr. Ruscio recommends talking to your doctor about your caloric goals and then if you do decide to add it and just start slow, you can learn a lot more about our elemental heel formulas@drrusheau.com eh you can order from there as well. So just visit drrusheau.come eh.

And I will say that my brother was very fortunate in that his kids were super kids. I mean when they were really young, you know, very little colic or tantrums. And so I think for him, and it's always hard to say, right, you know, kids come out of the oven different but you know, at least that small observation of two children and they were just phenomenal out of the gate in terms of they grew well, didn't have much or anything in the way of skin issues or other atopic conditions, had good behavior. So for him I think that was a great return on his time invested.

Absolutely. Yeah. Because then you're, I mean you're, when you get the food based nutrients, you're, you're just so much better to assimilate them too, you know, I mean your baby's just better, it's easier to use them. And I mean, when you look at the, the astounding, you know, number of kids who have chronic health concerns and it's just getting worse. You know, we have to, we have to start at the basics and start, you know, with, with food as medicine, start with their gut and, and ideally start when they are infants.

And this is a good segue, I think, into children, children, teens, you know, coming into the next several years of development. And I know that you want to talk about the gut brain connection, which I do too. Maybe we start with diet since we're just coming from diet. And one of the things that I've learned over time in terms of, okay, early in your career, you're really idealistic and then you interface with people who have limited time, limited resources. I always think about the single mother of two who's just, just trying to sort of tread water and do I need to give her a really strict idealistic diet plus no Teflon, plus all these other things and just make her feel so overwhelmed that she says, well, screw it, I'm not going to do anything because this list is just daunting. And especially with kids to be really light handed with dietary recommendations. Don't think about not eating this, think about eating that instead and framing it about being healthy, being fun, and just trying to generally avoid the whole framework or perspective handed down from the parent child that, you know, you're, you're sick, you're not feeling well. We have to do this really, avoiding anything with a negative valence and again, be light handed because knowing that children who do go on restrictive diets have a higher incidence of eating disorders in adulthood, I want to be really sensitive to that. How are you thinking about that and how do you approach that with your patients?

Yeah, I mean, it's absolutely, I mean, I've been doing this for, I mean, a little over 20 years now.

Longer than you want to admit. Yeah.

But you know, you start off when you, you know, when you're first training in functional medicine, you want to do all the things and you're so excited and you're like, oh my gosh, just, I know this is going to be helpful. And then as you said, you know, reality hits and you're, you realize, you know what, I can't just prescribe like 30 different supplements and say you have to live this really restrictive lifestyle in a bubble because that's not reality. And that may be stressful and inflammatory than, than the things that they were dealing with. Right. And so, you know, I've really, really moved back on the kind of the dogmatic view of what has to happen. And really, you know, you want to work in partnership with, with and with kids. It's the kids and the parents, right. You know, as, as a family unit, you know, for teenagers, it's, you know, really, really empowering them. No matter how, how old the kid is, you, you can always do some education at their level to help them understand why are we doing this? Why are we, you know, why are we doing some detective work with your poop, right. And checking your poop and, and you know, you know, what, what foods are going to be really strong for you and, and get them where, figure out what is motivating to them. Because for parents it's, I just, I want them to feel better, I want them to be healthier.

Right.

That's not going to cut it for kids. Right. Be healthy. Such a note, non term for them. And so, and, and for a lot of kids, they don't really know what is good health. What is that supposed to look like? And so, you know, especially for, for, I mean, I'll just say yesterday I had a teenager come in and you know, the, the mom was saying that the dad is all about, you know, probiotics and fish oils and has a bottle of fish oil for every kid in the family and the parents and you know, but you know, apart from the dad's bottle that, that goes empty, you know, within the month, like the kids and the mom just. Right.

Yeah, yeah.

And so I was chatting with the girl and I said, you know what I mean, there's omega threes because she came in, you know, to want to talk about how to help her acne. And I said, look, if you take that fish oil, it is really going to support healthier skin and hair. And she immediately perked up. Right. And her mom's like, oh my gosh, I think, I mean, that's probably the only reason she would take it. Right. And so if you knowing your audience. Absolutely, absolutely. And the other thing too is when you, oh, if you know that, you know, this child should be off of dairy or they really should be off of eggs for a little time or whatever it is. I never start with the elimination. You always want to introduce options, you know, swaps first before you take away. And you know, it's not a race, you know, as an adult, if, you know, like for me, if I were to go to you and you said, you know what, like, it looks like you should probably be off of soy and dairy and eggs for, you know, a Couple of months and I'd say, okay, great, take it out of my pantry and just do it right the next day or maybe a couple of days just to kind of get some stuff in order. But it's not, you can't do that with children. It's not, it's really not that race. It's that marathon and love that perspective. Yeah. And so, you know, I'll just tell parents, look, and kids, let's find some, you know, gluten free breads and pastas that you like. It's not going to taste like gluten pasta, but it can taste just as good. Right. Um, so not expecting it to be the same. Let's find some options for lunch, let's get in some dinner options, let's, you know, do some meal planning. And then once they have that down, have them set a date, look at the calendar where they're not going on vacation anytime soon. There's not a ton of birthday parties. There's not, whatever it is, and then put that on the calendar and then that's the date where they really start. Okay, now we know what foods we're going to start and what we can eat, what we like to eat. And you know, on the bottom are the foods that we're going to avoid for a little bit and then start it then. And so, you know, really, you know.

And you also give them sort of the perspective of this isn't necessarily forever, it's just an experiment to see how it feels to your body.

Absolutely. Absolutely. And you know, and sometimes for, you know, parents and kids who really are hesitant, resistant. I don't like to use the word resistant because that means I haven't educated well enough. Right. But you know, really more, more hesitant to start and you know, have some concerns about how they're going to be able to do it. I guess reluctant maybe is a better word. Right. And so, so then, so then, you know, really talking through and saying, well, you know, how about for two weeks, let's just try this for two weeks, but be 100% for those two weeks. Right. Because even that little bite, you know, of, of, you know, that baguette then, you know, can make the experiment not clean, you know, and then see how they feel. I also think when it comes to, um, it's one thing to, you know, for like maybe dad to be on a restrictive diet because he's got tummy issues or his joints are hurting and then everyone else eats a little differently, but I, that really shouldn't happen. You know, when you're working with a child, if there are other children at home, you don't want that child feeling like they're being singled out for, well, you know, why can't we have this? You know, why can't I have this when Johnny can? Or you just want to clean out your pantry, not have any temptation, make it so easy, easy, you know, to do this at home. And then you kind of work on what happens outside the home.

And have you ever found that a parent needs to be sort of reeled in where maybe they are overly avoiding food and now they're starting to pass that down to their children and sort of giving the children the paradigm of well, you can't go to the party or if you go to the party, you can't have the ice cream, you can't have the pizza, you can't have this, cannot processed food. Because I've seen this where some parents, again, they're well intentioned, they're so well intentioned and they're vigorously educating themselves. But it's sort of aggregating all the restrictions and no sort of filter to know when you don't need a restriction. So they end up overly restrictive. They pass that down to the kids and then you see it in how the kid sort of is a little bit hesitant or resistive because they're just getting so much pressure from the parents.

Yeah, 100%. And I think in a way it's, you know, not to, you know, blame us as, as you know, integrative functional health practitioners. But, but you know, in educating sometimes it's, it's hard to, you can't give all of the pieces of information at once. And so when you're pointing out, yeah, these ultra processed foods and too much added sugar and all of these emulsifiers and, and you know, the glyphosate and the X, Y and Z, they're harming your microbiome, they're harming their, your X, Y and Z. And so they're then yes, there's this fear now that a lot of people have around, well, I can't touch this, it's going to ruin my health. Oh my gosh, if my kid has those takis, it's going to destroy their gut microbiome. And so we want to know what to reduce and eliminate. But like we said before, sometimes the stress around what you can't eat is worse than actually just letting your kid have that blue frosted cupcake, you know, and so, you know, we want to do our best to educate our kids on why we choose healthier foods in our family, what these healthier foods mean, what these stronger foods are. And then also that we can build so much resilience in our gut microbiome, in our immune systems, in our brains, that, you know, every once in a while where we have maybe that, that boba tea or that, you know, Gatorade that I don't want my kids to have at the soccer games.

Right.

You're going to be okay. Right. Because we have all of those foundations. Because, you know, the thing with your gut microbiome is it even after disruption from antibiotics, let's say it wants to go back to the state it was in before. Right. I mean, it has that tendency. And so just think if you lay down for your child and for yourself, this amazingly healthy gut microbiome, which is not just the microbiota, but you know, that foundation, you know, that, that you know, the, the terrain of your, of your child's gut and your gut, it's going to want to go back and grow healthy things. And so, so, right. So really framing it that way so that. Okay, no, we don't want to eat, you know, soda and candy every single day. But look, if they go to sleepovers or if they're with grandma and grandpa for a week and, you know, maybe they're not quite on board, you know, with how you eat at home, it's okay.

Yeah. And one of the ways I think about this is we want to be careful not to become boring or losing any ability to have fun. Fun. And it's not to say all fun is tied to bad food. But, you know, I know some adults who, as they went through learning about health, they went from someone who we could go out and have fun with to living in a very narrow box. And it's like, boy, like, I, I get it. I fully get it. But, you know, every once in a while, you can have a few glasses of wine or some pizza or stay up late because with full disclosure, disclosure, I can count the most amount of laughing until my side hurt moments.

Yeah.

Usually being up too late, having a few drinks, eating bad food. And I really love the analogy of we want to be putting lots of deposits into the health bank. Yes. But then sometimes you get to withdraw. You get to spend some of that health on something that may not be pro health, but is pro soul, if you will. So, yeah, I think it's important we don't put our kids into these narrow confines and make them sort of, you know, boring.

Well, that, I mean, and I love that because you Know, as we were talking offline a little bit before the interview, I mean, we're all coming out of the pandemic craving, like in person interactions. And we know, I mean, you know, just the data on the healing power and actually the predictor of health that human connection has. I mean, you have to have that human connection. And, you know, and for our children, who really faced long before the pandemic, but really aggravated by the isolation of the pandemic, I mean, this huge mental health crisis and we cannot live in isolation. And in those moments. And yes, I do see some adults, not so much to kids, but some teens who are listening to the Huberman Lab and listening to different podcasts and really want to get very fit and are already thinking about biohacking, start being a little more restrictive. And, you know, we shouldn't. Kids shouldn't have to biohack and we should live in a way that we don't have to biohack when we're grown ups. Right. I mean, this is. And you cannot biohack your way out of, you know, not. Not living life in a way that supports an optimal brain, body, immune system.

Yep, yep, totally. No, Very, very well said. I know we wanted to get a little more into teen mental health. I think we've hit some of that with diet, some of that with mindset. Were there a few other things I know you had discussed or you had sent over some notes about antibiotics and birth control for skin, for gut health. That might be a big topic to unpack. I know you got about 10 minutes left, but is. Is there a few things there that you want to double click on briefly?

Yeah. So as it relates to teenage anxiety and just so, you know.

Adults, practitioners, grandparents, parents, teachers, I mean, we need to understand that now one in three teenagers has anxiety. By the time kids are 18, one in two are going to be diagnosed with any mental health disorder. I mean, one in two, right. And we know that ER visits for suicide attempts increased, especially for girls during the pandemic. Our youth, I mean, one in five teens has actually thought about suicide. Right. Seriously thought about suicide. Not just like, oh, I wonder what the meaning of life is, but one in five, seriously. And one in ten have tried. So, you know, you. If you work with kids, I mean, you are going to know a child who at some point will seriously contemplate, you know, ending their lives. And so, you know, suicide remains in our youth, I mean, teenagers to like mid-20s. The second leading cause of death, the first is actually accidental injury. Right. Which often goes hand in hand with the risk taking behaviors that we have when we might be contemplating suicide. But I mean, that's like way, way, way above the number of kids who have died from COVID or influenza every year. I mean, these are, it's so important to, you know, really recognize where are our public health dollars going when it.

Comes to it really puts it into perspective. You're right.

And so, I mean, something like, you know, 27 times more kids die by suicide than influencers influenza. Right? I mean, 27 times more. And so when we think about all the factors that go into teenage anxiety and depression, I mean, there's so many, right? There's the diet and lifestyle, not enough sleep and the screens and the isolation. But one thing that we have to also understand is the impact of the gut microbiome on their anxiety. And you know, as we mentioned, the majority of our neurotransmitters that affect our mood and our cognition are going to be made by the gut. And so, yes, antibiotics are a big disruptor, but parents don't necessarily think about that low dose of doxycycline that their teens are on for their acne. Right. Birth control pills also disrupt the gut microbiome. One study looked at ibuprofen, NSAIDs. You know, ibuprofen can disrupt the microbiome as much or if not more than antibiotics. And so if your kids are, you know, athletes and they're popping NSAIDs, you know, because they're bruised and achy, well, then we want to think about how do we support their gut microbiome. So I all of these things and you know, one of the things that I, when I look at kids guts and when they have anxiety is I really, I talk to them about what leaky gut is and what gut dysbiosis is. I want them to understand because one of the things that I found to be very helpful and in the literature there's some, some, even some animal data looking at addressing lipopolysaccharides, so endotoxemia and using serum derived bovine immunoglobulin to significantly reduce, reduce those anxiety symptoms and those depressive symptoms. And so, you know, if your child.

I may have missed that. Do you know when that was published? I'd love to see.

It was a while ago. I'll send you, I'll send you.

Yeah, please. No, that I didn't realize there was a connection to immunoglobulins and anxiety. I mean, it makes sense given lps, but. Yeah, please, please send me that.

Yeah, I mean, so that the endotoxemia is, is a big factor. And so, you know, so I just talk to kids about all the different things that can, that if, if they are really motivated to really work on their anxiety and their mood, all the different things that can affect them, and then asking them, you know, we want to work on the gut, but how do you want to work on that? Right. You know, and we take it one.

Step at a time because some kids don't want to change their diet or it's really hard. Maybe they're at college, living in the dorms, at the whims of the residential cafeteria food. And it's like, okay, we're going to use probiotics, immunoglobulins, you know, and support as best we can. But right now is not the best time for diet. So I think that just needs to be, be reverberated for clinicians, you know, know your audience and check in with them. You know, we could do this or the other thing or this other thing. Which one appeals most to you? Because the best plan, as I know, you know, is the one someone will follow.

And that's where, you know, I, I feel like coming back, returning, you know, after, through the pandemic now to almost all in person visits, especially for your teenagers. It's so invest valuable or at least it has to be by zoom, not on the phone. And their camera has to be on because you can see when you start listing some interventions and they start looking away, right? Or they kind of, or, you know, their shoulders start to slump or they kind of, you know, start tapping on the table and you're like, okay, I gotta stop right now, reframe and figure out how to, you know, get, get them back to, you know, being in the room and, and you know, wanting to engage. And so, and for some kids, I mean, when you talk about diet, it's not about like if, if they are, are. I mean, I have one kiddo who every morning and she said, this is not, she's not going to give this up every morning. She has a Red Bull every morning, right? And that's the one thing that she's not going to give up. So I said, all right, okay, we're going to work with that. Pick your battles.

Sure.

Yeah. But then let's look and see. And so she was also, you know, going, you know, to downtown with her friends and she was mostly like, she loved Thomas Takis. Right? And I give the Takis example because there's the artificial colors and the, the, you know, the the artificial additives and all of that in there. And I said, look, let's just make a swap then. I'm not gonna tell you not to eat chips. I mean, most kids would look at me like I'm crazy. But let's learn how to then, you know, if you're going out, let's learn how to read the label so that you can choose a better chip for you, a chip that's going to support your gut microbiome. Right. You know, go to Trader Joe's and get the. Their chili lime corn chips or, you know, the siete fuego chips or, you know, whatever. So.

Those are delicious.

Yeah, those are so good. And, you know, they're so much better for your microbiome and your brain than. Than the artificial dyes and the ingredients in the Takis. And so it's really educating them. You know, where are they at if they're in college, like you said, not much they can do if they're on dorm food. But then, you know, okay, if, you know, if they're in the cafe cafeteria is. How about. Let's think about what foods have fiber for your gut and maybe choose one, you know, at each meal. Right. There's always some, like a. There's always a tiny way we can uplevel, you know, what. What they're doing.

Sure. Love it. Well, I feel like we could talk for another hour, but I want to be respectful of your time. Do you want to make people aware of website, social media, wherever you kind of want to point them to?

Yeah. So my website is HealthyKids Happy Kids.com and one of the best ways to find me is on Instagram at it. That's at Healthy Kids underscore Happy Kids.

Awesome. Well, great conversation. I really appreciate your perspective. I think we need more of you out there in the world. You know, good people working in pediatrics and helping kids. So folks, if you need help, look her up. And Elisa, thank you so much again for taking the time.

Oh, you're so welcome. And I have a plug for your book. I have it. It's really great, so. Oh, thank you. And so, you know, when we think about the microbiome, I mean, there's so much information out there. So, I mean, do your reading and, and your, you know, for. For kids. I just, I'd love them to read too. I mean, there are some kid. Little kid stories out there too. So. And. And I'm just going to give a plug. Cause I have a book coming out just on this topic in. Yeah. In. In May of 2024, so we'll be looking out for that.

Nice. Well, yeah, we'll probably want to have you come back on and. And just, you know, give us sort of a rundown and put this on people's radar. So open invitation to come back when you're ready.

Oh, anytime. Yeah. It's been so great talking about.

All right. You, too. Thank you again.

Bye.

Bye.

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